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MARCH 2018
Type III
Lower
7-10%
Fracture plane passes some distance along the growth plate and
down through the epiphysis
Poorer prognosis as the proliferative and reserve zones are
interrupted
Type IV
Transverse fracture: A fracture that is at a right angle to the Through or transverse or together
bone's long axis. Intra-articular
Oblique fracture: A fracture that is diagonal to a bone's long 10%
axis. Fracture plane passes directly through the metaphysis, growth
Spiral fracture: A fracture where at least one part of the bone plate and down through the epiphysis
has been twisted. Poor prognosis as the proliferative and reserve zones are
Comminuted fracture: A fracture in which the bone has broken interrupted
into a number of pieces.
Type V
Impacted fracture: A fracture caused when bone fragments are
Ruined or rammed
driven into each other.
Uncommon <1%
Crushing type injury does not displace the growth plate but
SALTER HARRIS FRACTURE
damages it by direct compression
Worst prognosis
Type I
Slipped
5-7%
Fracture plane passes all the way through the growth plate, not
involving bone
Cannot occur if the growth plate is fused
Good prognosis
Type II
Page 1 of 12
“Vitanda est improba siren desidia”
CD B: RADIO | IMAGING OF THE UPPER AND LOWER EXTREMITIES
MARCH 2018
CLAVICLE
Between sternoclavicular and acromioclavicular joints
Chest x-ray
Clavicle overlies the lung apices
Distance of the medial end of the clavicle and spinous
process of the vertebra is equal on both sides unless patient
is rotated
SCAPULA
Flat, triangular bone with 3 processes
Glenoid process
Spine
Separates the supraspinous from the infraspinous
fossae
Extends laterally as the acromion
Coracoid process
Radiologic features:
Plain x-ray
Scapula lies over the ribs and some of the lung fields in PA
chest x-ray unless the shoulders are rotated
HUMERUS
Head of the humerus is separated from the greater and lesser
tubercles by the anatomical neck
Bicipital groove: between the tubercles for the long head of
the biceps
Surgical neck: narrow shaft just below the tubercles
Deltoid tuberosity
On the lateral aspect of the midshaft
Site of insertion of the deltoid muscle
Distal end of the humerus: medial and lateral epicondyles
Capitulum: articular surface or the elbow joint for articulation
with the radial head
Trochlea: for the olecranon fossa of the ulna
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CD B: RADIO | IMAGING OF THE UPPER AND LOWER EXTREMITIES
MARCH 2018
SHAFT
SURGICAL NECK
RADIUS & ULNA
RADIUS
Has a cylindrical head that is separated from the radial
tubercle and the remainder of the shaft by the neck
Lower end is expanded -- most distal part is radial styloid
ULNA
Upper part of the ulna (olecranon) is hookshaped, with the
concavity of the hook (trochlear fossa) anteriorly
Styloid process at the distal end is narrower and more
proximal than that of the radius
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CD B: RADIO | IMAGING OF THE UPPER AND LOWER EXTREMITIES
MARCH 2018
COLLES’ FRACTURE
MOI: fall on an outstretched arm
Fracture of the distal radius and ulna with dorsal angulation
SMITH’S FRACTURE
MOI: fall on an outstretched arm
Fracture of the distal radius and ulna with ventral angulation
MONTEGGIA FRACTURE
Fracture of the proximal third of the ulna with dislocation of the
head of the radius
GALLEAZZI FRACTURE
Fracture of the radius with distal ulnar dislocation
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“Vitanda est improba siren desidia”
CD B: RADIO | IMAGING OF THE UPPER AND LOWER EXTREMITIES
MARCH 2018
CARPAL BONES
Arranged in two rows of four each
Form an arch, with its concavity situated anteriorly
Flexor retinaculum converts the arch of bones into a tunnel --
carpal tunnel
Conveys the superficial and deep flexor tendons of the
fingers and the thumb (except flexor carpi ulnaris and
palmaris longus tendons) and the median nerve
Radiography
Radiographed in the anteroposterior, lateral and oblique
positions
Supernumerary bones
Found in the wrist
Os centrale THUMB (BENNETT’S FRACTURE)
Found between the scaphoid, trapezoid and capitates Fracture at the base of the thumb
Intra-articular fracture/dislocation of base of 1st metacarpal
May represent the tubercle of the scaphoid that has
Small fragment of 1st metacarpal continues to articulate with
not fused with its upper pole
Os radiale externum trapezium
Lateral retraction of 1st metacarpal shaft by abductor pollicis
Found on the lateral side of the scaphoid distal to the
longus
radial styloid
Nutrient arteries of the scaphoid
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“Vitanda est improba siren desidia”
CD B: RADIO | IMAGING OF THE UPPER AND LOWER EXTREMITIES
MARCH 2018
BOXER’S FRACTURE
Fracture of the 2nd to 5th metacarpals
The end of the 5th metacarpal takes the force of impact and
breaks at its neck and angulates towards the palm creating a SHOULDER (GLENOHUMERAL JOINT)
dorsal bump
A ball-and-socket synovial joint
Articular surfaces
Head of the humerus
Glenoid cavity of the scapula
Synovium
Ligaments
PHALANGES (FRACTURES)
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CD B: RADIO | IMAGING OF THE UPPER AND LOWER EXTREMITIES
MARCH 2018
Posterior
Difficult to diagnose
AP film – normally, humeral head slightly overlaps the
glenoid, forming the crescent sign in posterior
dislocation, this crescent appearance is lost
Page 7 of 12
“Vitanda est improba siren desidia”
CD B: RADIO | IMAGING OF THE UPPER AND LOWER EXTREMITIES
MARCH 2018
Page 8 of 12
“Vitanda est improba siren desidia”
CD B: RADIO | IMAGING OF THE UPPER AND LOWER EXTREMITIES
MARCH 2018
THIGH
Femur
The femur consists of a shaft, a neck, and a head, which
articulates with the acetabulum.
The patella is a flattened sesamoid bone within the
quadriceps tendon.
Posterior Dislocation
Anterior Dislocation
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CD B: RADIO | IMAGING OF THE UPPER AND LOWER EXTREMITIES
MARCH 2018
Supracondylar Fracture
KNEE JOINT
Modified hinge joint
This synovial joint is the largest in the body
Comprises two condylar joints between the femoral and
corresponding tibial condyles and a saddle joint between the
patella and the femur.
The tibiofemoral compartments are each divided by a
fibrocartilaginous meniscus.
Medial meniscus is larger and more semicircular
Lateral is smaller, thicker and forms a nearly complete ring.
Meniscal tear
Menisci elongated triangles in profile
Uniformly black or of low signal intensity signal extending
to and through surface of the meniscus
Bucket-handle tear medial meniscus - most common KNEE FRACTURES
Lies beneath and parallel to the posterior cruciate ligament
(PCL), double PCL'' sign of buckethandle meniscus tears
Flipped meniscus ''sign ,torn posterior horn of the meniscus
flipped or inverted anteriorly
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CD B: RADIO | IMAGING OF THE UPPER AND LOWER EXTREMITIES
MARCH 2018
PATELLAR DISLOCATION
ANKLE JOINT
LOWER LEG
The tibia and fibula
These are joined by a tough fibrous interosseous
membrane.
They give rise to the attachments of many of the muscles
of the lower leg.
The tibiofibular joints
Superior tibiofibular.
Inferior tibiofibular joint
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“Vitanda est improba siren desidia”
CD B: RADIO | IMAGING OF THE UPPER AND LOWER EXTREMITIES
MARCH 2018
ANKLE FRACTURE
FOOT
Lisfranc’s fracture
Serious fracture in the foot
Fracture-dislocations of the tarsometatarsal joints
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“Vitanda est improba siren desidia”